Reactions 996 - 10 Apr 2004

SRopivacaine

Seizures, hypotension and respiratory arrestfollowing inadvertent intravascular administration:case report

Inadvertent intravascular injection of ropivacaine wasfollowed by a generalised tonic-clonic seizure, hypotensionand respiratory arrest in a 36-year-old man.

The man underwent elective total hip arthroplasty undercombined spinal epidural anaesthesia with bupivacaine,sufentanil and clonidine. After completion of the uneventfulprocedure, the ropivacaine prepared for postoperativeepidural infusion was inadvertently connected to a peripheralIV line. He received approximately 200mL of 0.15%ropivacaine (300mg) intravenously over approximately5 minutes. He suddenly developed confusion, disorientation,marked anxiety and motor hyperactivity. He then becameunresponsive to verbal commands and developed generalisedtonic-clonic movements, followed by loss of consciousnessand respiratory arrest. His arterial BP had decreased to65/35mm Hg with slight tachycardia.

The man was treated with oxygen, IV ephedrine and IVpropofol sedation and his seizures resolved. He underwenttracheal intubation facilitated by suxamethonium chloride. Theropivacaine solution was immediately replaced by a colloidsolution, and he was treated with IV sodium bicarbonate andfurther ephedrine. After the seizure, he was found to havehypercapnia and acidosis. He soon became haemodynamicallystable and propofol was stopped 15 minutes later. He regainedconsciousness and was extubated 15 minutes later. Herecovered completely without sequelae. Subsequent analysisof plasma samples revealed ropivacaine concentrations of 3.1,1.94 and 1.47 µg/mL at 20, 90 and 150 minutes after theadministration of ropivacaine. The estimated peak plasmaropivacaine concentration was 17.04 µg/mL.Dernedde M, et al. Grand mal convulsion after an accidental intravenous injectionof ropivacaine. Anesthesia and Analgesia 98: 521-523, No. 2, Feb 2004 -Belgium 800965453

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Reactions 10 Apr 2004 No. 9960114-9954/10/0996-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved